The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

Medical liability reform is one of those causes that, up to now, has seemed a political impossibility at the federal level. Even in years when Republicans controlled both the U.S. Senate and House, tort reform advocates couldn’t muster sufficient votes to get legislation passed. A number of states have enacted reform measures, but Congress – encouraged by strong lobbying from the nation’s trial attorneys – has stubbornly refused to rein in even the most meritless lawsuits.

Now, though, we’re seeing a number of actions taking place that indicate there may be an opening to get something done on liability reform. Among them:

• There is increasing interest in innovative measures such as tying liability protections to usage of health information technology and evidence-based medicine.

There are compelling reasons for Congress to move on this issue. We have to be concerned about having a sufficient supply of physicians to serve an insured patient population that will increase as a result of health reform. In many states, the liability climate forces physicians into early retirement. We’re concerned about making our healthcare system more cost efficient, and yet the current liability system forces the expenditure of dollars in ways that don’t benefit patients. President Obama’s right. It’s time to make progress on this issue.

While taking more than their fair share of rhetorical abuse (and, yes, I’ve been guilty of that), they have the difficult task of crafting rules that reflect the intent of the legislation that enabled them, protect citizens from a variety of imaginable harms and do so without unnecessarily impeding economic growth.

In an increasingly complex world, it’s a difficult balance to strike and maintain. That’s why President Obama’s executive order to review federal regulations is a sound and welcome action. As the President stated, it’s essential to “strike the right balance” between protecting the public’s well-being and ensuring robust economic growth and job creation.

To that balance, I would also add the necessity to encourage innovation.

The Food and Drug Administration demonstrated good judgment in that regard this week in its rulemaking to fine-tune the 510(k) process. The 510(k) approval process is used for medical devices that are very similar to already-approved process. It enables manufacturers to make small improvements in a healthcare product without having to go through the lengthy and expensive approval process required of brand new innovations.

The FDA approved a number of changes to streamline and improve the 510(k) process and asked the Institute of Medicine to give its expert opinion on other proposed changes that some experts fear could slow down the approval process without delivering any real benefits to patients and healthcare consumers.

As I said, it’s not easy being a regulator, but the process is at its best when, as both President Obama and the FDA showed this week, there is an awareness that the balance must be maintained between consumer protection and innovation and economic growth.

Next Wednesday, the U.S. House of Representatives is scheduled to vote on legislation repealing the Affordable Care Act that the 111th Congress passed just last year. Presuming that the U.S. Senate will not follow the House’s lead, next week’s vote begins what could be a very difficult and contentious process to determine the future of health reform.

Brooks writes, as so many have in recent days, on the need for greater civility in our political discourse, but he takes it a step further and says that civility won’t come unless we each begin to recognize our own fallibility and that we achieve more through collaboration and cooperation than by going it alone.

He writes, “…even if you are at your best, your efforts will still be laced with failure. The truth is fragmentary and it’s impossible to capture all of it. There are competing goods that can never be fully reconciled. The world is more complicated than any human intelligence can comprehend.

“But every sensible person in public life also feels redeemed by others. You may write a mediocre column or make a mediocre speech or propose a mediocre piece of legislation, but others argue with you, correct you and introduce elements you never thought of. Each of these efforts may also be flawed, but together, if the system is working well, they move things gradually forward.”

It’s unfortunate that the health reform process from the beginning turned into a rhetorical battle of absolutes. To this day, among politicians and pundits alike, either you’re for the Affordable Care Act or you’re against it. The debate has always been framed in terms of all-or-nothing stakes. Yet, who can reasonably argue that a measure this complex wouldn’t have both flaws that need correcting and positives worth preserving?

When Congress finishes its action on repeal legislation, it would be a positive step to see a broad acknowledgement that health reform can be made better if it incorporates the best ideas from both parties, that we need to expand coverage, achieve greater affordability and promote a vibrant role for private sector innovation.

A Rasmussen survey released today shows that only 18 percent of the American public wants to see the health reform law left in place as it is. Yet, surveys also show that voters don’t want to see reform scrapped completely. It’s not healthy to have the public so bitterly divided on an issue of such vast importance. I’m no pollster, but I suspect there would be widespread public approval if all sides decided to, as Brooks wrote, acknowledge their fallibility and work together to craft genuinely bipartisan, effective solutions for our nation’s healthcare system.

In this space, I’ve frequently discussed the need for U.S. policymakers to address the future of medical innovation in this country. Confronted with an aging population and chronic disease on the increase, will our society invest in developing new cures and medical technologies? Will the United States continue to be synonymous with healthcare advancements?

For those who prefer a graphic approach to these questions, I highly recommend a web video produced by the Council for American Medical Innovation (CAMI). In just a little over two minutes, it spells out the impact innovation has made in conquering diseases like polio and reducing deaths from AIDS and other serious illnesses, while spotlighting the challenges – such as diabetes and Alzheimer’s Disease – that still need to be confronted.

On this topic, CAMI is hosting an important event tomorrow (January 12). The symposium, Medical Innovation at the Crossroads: Choosing the Path Ahead, will feature a number of knowledgeable speakers including former HHS secretary Mike Leavitt, former House Democratic Leader Dick Gephardt, PhRMA President and CEO John Castellani, Cleveland Clinic Innovations executive director Chris Coburn, and best-selling author and CNN contributor Dr. Fareed Zakaria. They will be discussing federal policies that affect innovation and the challenge of investing in healthcare innovation in times of fiscal restraint. It’s taking place from 8:30 a.m. to 12:30 p.m. at the Newseum in Washington, DC.

Even before Congress passed the Affordable Care Act, the actual process of reforming our healthcare system was already taking place at locales throughout the country. In all sectors of American healthcare, we’re seeing innovators who are developing new and better ways of delivering high-quality, cost-effective care to patients.

The publication SmartBusiness spotlighted one of these innovators, Barry Arbuckle, Ph.D., the president and CEO of the MemorialCare Health System in southern California. In an interview, Dr. Arbuckle discussed how physicians in the MemorialCare system are practicing evidence-based medicine that is bringing about patient outcomes that “frequently exceed state and national averages for most diseases.”

In the interview, Dr. Arbuckle, a member of the Healthcare Leadership Council, also discussed the critical role of electronic patient records and offers advice for employers on the questions they need to ask to ensure the best possible healthcare for their employees.

The theme of best practice, evidence-based medicine is one we’re going to hear about frequently as the nation’s healthcare system continues to transform itself.